Reoperation Rate After Microsurgical Uni- or Bilateral Laminotomy for Lumbar Spinal Stenosis With and Without Low-grade Spondylolisthesis

Schär, Ralph T.; Kiebach, Stefanie; Raabe, Andreas

doi:10.1097/brs.0000000000002798

Cited by 12 publications

(8 citation statements)

References 30 publications

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“… 34 Similarly, Schär et al performed a retrospective single-center cohort study with a mean follow-up of 4.1 years and found that 14.9% of patients with LSS treated by microsurgical laminotomy underwent a second surgery. 32 Compared with these studies using microsurgical procedures, the present study found a slightly lower reoperation rate of 6.7% in patients with LSS treated with PETD at a mean follow-up of 3 years. In addition, some studies have compared the clinical outcomes of endoscopic and microsurgical techniques.…”

Section: Discussioncontrasting

confidence: 62%

“…Few studies have reported the reoperation rate of microsurgical decompression for LSS. 25,[31][32][33][34] In a minimum 5-year follow-up study, Hiromitsu et al found a 7% reoperation rate after microsurgical decompression for LSS. 34 Similarly, Schär et al performed a retrospective single-center cohort study with a mean followup of 4.1 years and found that 14.9% of patients with LSS treated by microsurgical laminotomy underwent a second surgery.…”

Section: Discussionmentioning

confidence: 99%

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Reoperations After Percutaneous Endoscopic Transforaminal Decompression for Treating Lumbar Spinal Stenosis: Incidence and Predictors

Wang

Zang

et al. 2022

Global Spine Journal

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Study Design Retrospective cohort study. Objectives The main purpose of the present study was to report the incidence and identify predictors of reoperation in patients with lumbar spinal stenosis (LSS) treated with percutaneous endoscopic transforaminal decompression (PETD). Methods This study retrospectively reviewed consecutive patients with LSS who underwent PETD at our center between January 2016 and July 2020. The incidence of reoperations was calculated. We then designed a surgical period-matched case-control study to identify predictors among demographic data, clinical baseline data, and imaging parameters. Results This study identified 496 eligible patients. 33 (6.7%) patients underwent reoperation with a mean follow-up of 3 years, consisting 22 (4.4%) at the index level and 11 (2.2%) at the adjacent levels. There were significant differences in age and age-adjusted Charlson comorbidity index (AACCI) between the two groups, with younger age (P = .004) and lower AACCI (P = .019) in reoperation group. Age was identified as the sole independent predictor (P = .006). The duration of symptoms ≥12 months (P = .034) and the presence of heart problems (P = .012) were recognized as specific predictors among patients younger than 65 years. Conclusions In a mean follow-up of 3 years, the incidence of reoperation in LSS treated with PETD was 6.7%. A younger age was the independent predictor for reoperation. Younger patients with the duration of symptoms ≥12 months or without heart problems were more likely to undergo a second operation. Prospective randomized controlled trials are required to confirm these findings.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Reoperations After Percutaneous Endoscopic Transforaminal Decompression for Treating Lumbar Spinal Stenosis: Incidence and Predictors

Wang

Zang

et al. 2022

Global Spine Journal

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“…The overall revision rate to address recurrent symptoms at the index level or adjacent segments is reported between 10-25% [58][59][60]. These results correspond with our findings.…”

Section: Discussionsupporting

confidence: 92%

Lumbar spinal stenosis – surgical outcome and the odds of revision-surgery: Is it all due to the surgeon?

Melcher¹

2022

THC

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BACKGROUND: Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when non-operative treatment has failed. Apart from acute complications such as hematoma and infections, same-level recurrent lumbar stenosis and adjacent-segment disease (ASD) are factors that can occur after index lumbar spine surgery. OBJECTIVE: The aim of this retrospective case series was to evaluate the outcome of surgery and the odds of necessary revisions. METHODS: Patients who had undergone either decompressive lumbar laminotomy or laminotomy and spinal fusion due to lumbar spinal stenosis (LSS) between 2000 and 2011 were included in this analysis. Demographic, perioperative and radiographic data were collected. Clinical outcome was evaluated using numeric rating scale (NRS), the symptom subscale of the adapted version of the german Spinal Stenosis Measure (SSM) and patient-sreported ability to walk. RESULTS: Within the LSS- cohort of 438 patients, 338 patients underwent decompression surgery only, while instrumentation in addition to decompression was performed in 100 cases (22.3%). 38 patients had prior spinal operations (decompression, disc herniation, fusion) either at our hospital or elsewhere. Thirty-five intraoperative complications were documented with dural tear with CSF leak being the most common (33/35; 94.3%). Postoperative complications were defined as complications that needed surgery and differentiated between immediate postoperative complications (⩽ 3 weeks post operation) and complications that needed revisions surgery at a later date. Within all patients 51 revisions were classified as immediate complications of the index operation with infections, neurological deficits and hematoma being the most common. Within this group only 22 patients had fusion surgery in the first place, while 29 were treated by decompression. Revision surgery was indicated by 53 patients at a later date. While 4 patients decided against surgery, 49 revision surgeries were planned. 28 were performed at the same level, 10 at the same level plus an adjacent level, and 10 were executed at index level with indications of adjacent level spinal stenosis, adjacent level spinal stenosis plus instability and stand-alone instability. Pre- operative VAS score and ability to walk improved significantly in all patients. CONCLUSIONS: While looking for predictors of revision surgery due to re-stenosis, instability or same/adjacent segment disease none of these were found. Within our cohort no significant differences concerning demographic, peri-operative and radiographic data of patients with or without revision wer noted. Patients, who needed revision surgery were older but slightly healthier while more likely to be male and smoking. Surprisingly, significant differences were noted regarding the distribution of intraoperative and early postoperative complications among the 6 main surgeons while these weren’t obious within the intial index group of late revisions.

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“…17 The analysis to find any preoperative predictors of instability did not show that disc height could be predictive. Although our findings are extremely limited by the size of our group, they corroborate the findings of Schär et al 25 The limitations of our study are obvious (small number, retrospective nature, selection bias related to patients' ability to get to the study facility).…”

Section: Discussionsupporting

confidence: 87%

Upright MRI after decompression of spinal stenosis and concurrent spondylolisthesis

Kern

Setzer

Weise

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe treatment of patients with spinal stenosis and concurrent degenerative spondylolisthesis is controversial. Two large randomized controlled clinical trials reported contradictory results. The authors hypothesized that a substantial number of patients will show evidence of micro-instability after a sole decompression procedure.METHODSThis study was a retrospective analysis of all cases of lumbar spinal stenosis treated at the Frankfurt University Clinic (Universitätsklinik Frankfurt) from 2010 through 2013. Patients who had associated spondylolisthesis underwent upright MRI studies in flexion and extension for identification of subtle signs of micro-instability. Clinical outcome was assessed by means of SF-36 bodily pain (BP) and physical functioning (PF) scales.RESULTSA total of 21 patients were recruited to undergo upright MRI studies. The mean duration of follow-up was 65 months (SD 16 months). Of these 21 patients, 10 (47%) showed signs of micro-instability as defined by movement of > 4 mm on flexion/extension MRI. Comparison of mean SF-36 BP and PF scores in the group of patients who showed micro-instability versus those who did not showed no statistically significant difference on either scale.CONCLUSIONSThere seems to be a substantial subset of patients who develop morphological micro-instability after sole decompression procedures but do not experience any clinically significant effect of the instability.

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Reoperation Rate After Microsurgical Uni- or Bilateral Laminotomy for Lumbar Spinal Stenosis With and Without Low-grade Spondylolisthesis

Abstract: 4.

Cited by 12 publications

References 30 publications

Reoperations After Percutaneous Endoscopic Transforaminal Decompression for Treating Lumbar Spinal Stenosis: Incidence and Predictors

Reoperations After Percutaneous Endoscopic Transforaminal Decompression for Treating Lumbar Spinal Stenosis: Incidence and Predictors

Lumbar spinal stenosis – surgical outcome and the odds of revision-surgery: Is it all due to the surgeon?

Upright MRI after decompression of spinal stenosis and concurrent spondylolisthesis

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